Epiglottic abscess and the management of a ‘precious airway’: A case study

Abstract

An epiglottic abscess is a rare, life-threatening cause of acute airway obstruction with a mortality of 30%, requiring immediate management with a multidisciplinary specialist team. Since HiB immunisation was introduced epiglottitis and epiglottic abscess incidence has dramatically reduced, though it has risen again in recent times due to other pathogens.We present a case of a 45-year-old gentleman who presented with odynophagia, throat pain and reduced oral intake. He was diagnosed using CT imaging with contrast and flexible nasolaryngoscopy and commenced on IV antibiotics and steroids. Definitive management of the airway was achieved with an awake fibreoptic intubation (AFOI) with tracheostomy set on standby. He underwent a second washout in theatres day 6 and was extubated day 7. Prior to discharge, he experienced postextubation dysphagia that fully recovered prior to his discharge day 13. This paper explores the need for prompt securing of the airway, the advantages of AFOI and the post-operative course of epiglottic abscesses.

Spontaneous epiglottic abscess: pathophysiology and airway management options

“…Epiglottic abscess is a rare disease in the modern era, owing to the availability of a wide range of antibiotics and modern investigation techniques [ 6 ]. It represents a serious complication of epiglottitis and exclusively affects adults [ 7 , 8 ].…”

Epiglottitis and Complicated Epiglottitis – A Narrative Review

“…It is more correctly called supraglottitis. Complicated epiglottitis usually involves a coalescent abscess containing pus in the supraglottic region in the oropharynx [1]. Other rare and uncommon complications of epiglottitis include descending necrotizing mediastinitis [2].…”

An Atypical Cause of an Epiglottic Abscess

“…An epiglottic abscess is a rare complication of acute epiglottitis that is characterized by supraglottic collection of pus [1]. Although acute epiglottitis is commonly seen in children [2], an epiglottic abscess tends to be a disease of adults [3].…”